Abstract

Stercoral perforation is defined as “perforation of the bowel due to pressure from a faecal mass.” This is due to an accumulation of stool that has hardened and has remained in the bowel over a long period of time causing stagnation and deformity of the large intestine.

At 25 weeks gestation a lady attended with severe constipation despite various stimulants/enemas and left sided abdominal pain. She started vomiting and felt generally unwell. She had abdominal distension and sluggish bowel sounds. Haematology and biochemistry were normal. Ultrasound showed large amounts of gas in the bowel but was otherwise unremarkable. The surgeons reviewed her, excluded any obstruction and continued conservative management with observation and laxatives. Her pain and constipation continued until she became tachycardic and tachyopneic, her CRP began to rise. Prophylactic steroids were given. Antibiotics were commenced and urgent MRI arranged. MRI showed no obvious stricture or structural obstruction. A Naso-gastric tube was passed draining bilious fluid. Throughout the day her clinical condition deteriorated. She was transferred to delivery for critical care review and surgical input.

She eventually went to theatre for a de-functioning iliostomy. At laparotomy bowel perforation was identified with faecal peritonitis. She had a colectomy. Due to maternal condition and access and post operative considerations the baby was delivered by caesarean section.

Although constipation is common amongst pregnant women it is usually corrected by conservative measures such as stimulants/enemas and adequate hydration. Refractory cases should prompt early referral for investigation for underlying pathology.